Targeting and the silting-up of resources in the community-based social services: the consequences of alternative policies

<p>The policy context is the pressure of demand on resources in home care at a time when the policy aim is to achieve the a switch in the balance from residential-based to home-based care.

<p><p><p>The research context is the authors' set of papers estimating the implications of how resources of the community-based social services were used in relation the needs of users during the mid- and late 1980's, and the implications of variations in actual behaviour and hypothetical strategies for resource distributions and demands. (The topics of other papers and books include charging behaviour and its effects on demand, the 'marginal costs' and 'marginal productivities' of services in the production of outcomes of value in their own right given the need-related circumstances of users, the predictors of variations in the lifetime costs of services, the sensitivity of numbers who require subsidised CBSS to variations in the stringency of targeting criteria with respect to physical disabilities, cognitive impairment and associated behavioral disabilities and income eligibility criteria.)

<p><p><p>The aim of the paper is to quantify the resource effects over five years of

<p><p><p>(a) targeting and service review in a hypothetical whose behaviour reflected the average over 12 areas in England and Wales;

<p><p><p>(b) targeting and service review in the two of these areas which respectively targeted most at the least dependent and the most dependent;

<p><p><p>(c) the pattern of allocation of the hypothetical authority but excluding those which were not disabled with respect to the main tasks performed by standard home help or meals services; and

<p><p><p>(d) the same pattern as (c) but also excluding those whose conditions had improved by the time of successive six-month reviews to a level at which they were not disabled with respect to those tasks.

<p><p><p>The results suggest the quantitative importance of accompanying changes in initial targeting with the allocation of service for set periods, with renewal of service made dependent on rigorous six-monthly reviews.